December 2015
MEMORANDUM
TO:
Renewal Charitable Organizations Applying for Inclusion in the
2016-2017 State of Georgia's Charitable Contributions Program
FROM:
La Toya Wimbush, Program Manager
State Charitable Contributions Program
SUBJECT:
2016-17 Application for Renewal
Following you will find the 2016-2017 State Charitable Contributions Program application for renewing
participants. If you wish to apply to be a participating charity, please complete the following application with all
requested documentation. If your administrative percentage is above 25%, please submit a brief explanation.
Please note that if your organization is affiliated with a national charitable organization, a Form 990 or other
financial documentation must be submitted showing revenues and expenses for Georgia on an explicitly
isolated basis. Only the stated documents are required, so you do not need to submit more documentation.
Applications will be reviewed for completion as they are received and you will be contacted regarding any
missing documentation.
Your completed application should be mailed to my attention and must be postmarked no later than February
16, 2016 to the following address:
SCCP Manager – RE: SCCP Application
HR Administration Division
Department of Administrative Services
200 Piedmont Avenue
Suite 520, West Tower
Atlanta, GA 30334
Failure to submit your completed application by February 16 will result in your organization not being
approved for participation in the 2016-2017 program. A paper copy of your completed application is required
to be kept in the SCCP offices; therefore, electronic copies will not be accepted. On the final page, the form asks
for the signature of both the President and Executive Director. We ask for both to be signed, but the application
will be accepted if only one signature is available. We also understand some organizations have one person in
both roles. The service area requirement may be completed by simply writing in the number served on the
available map or completing the document that logs all served per county.
If you do not have a current charity registration with the Georgia Secretary of State’s office, you should contact
the SoS office regarding whether you are required to register or exempt. Either way, you must submit either a
printout of the screen showing your current status, the application you are submitting as a newly registered
organization or a letter detailing why you are exempt. Exemptions are listed at the end of the application. The
website is located here: http://verify.sos.ga.gov/websites/verification/Search.aspx?facility=Y Under Profession
choose Charities and License Type choose Charity. Search for your organization’s name in the
Business/Company Name field using the * as a wildcard. Don’t just type in Cancer, but type Cancer* to pull up all
charities with cancer in the name. Find yours, click on the name and the printout of that screen can serve as
proof.
Page 1 of 7
Revised 3/16/16
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
Charitable Contributions Program staff will be available to answer questions regarding the application by
telephone (404-651-6084) or email sccp@doas.ga.gov.
Thank you for your interest in the State Charitable Contributions Program.
Sincerely,
La Toya Wimbush
SCCP Program Manager
Page 2 of 7
Revised 3/16/16
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
1.
Name of Charitable Organization:_____________________________________________
2.
We do ____, do not ____, wish to continue as a participant in this program.
3.
Is your organization
_____ an independent, statewide charitable organization, or
_____ a federation that coordinates fundraising and allocations for other member charitable organizations?
Note: If you are a federation, please attach a current members listing and
assign SCCP numbers to new members. Indicate clearly which members are new.
4.
Note the following changes in our basic organizational structure or function and our program services since we
filed the last application:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
5.
Attach listing of applicant's current Officers and Directors, including the business or home address of each.
6.
List the name, business address, telephone number, FAX number and Internet Email address of the contact
person for your organization.
Name and Address________________________________________________________
City, State, ZIP__________________________________________________________
Telephone________________FAX______________________Email_________________
Secondary Contact (optional):
Name and Address________________________________________________________
City, State, ZIP__________________________________________________________
Telephone________________FAX______________________Email_________________
7.
Organizations applying for inclusion as an independent, statewide charitable organization, list the name of
each county in Georgia served by your organization, identify services provided and indicate the number of clients
receiving each type of service in each county your organization served in 2014 or 2015. You may use the attached
Listing of Service Area form, which lists acceptable service categories, to provide this information, or you may
provide this information in an alternate format.
8.
Organizations applying for inclusion as a federation that coordinates fundraising and allocations for
other charitable organizations, list your member agencies, including a description of the purpose and
services provided, geographic area served and the number of clients served by each in 2014 or 2015. You
may use the Listing of Service Area form, which lists acceptable service categories, to provide this
information, or you may provide this information in an alternate format like a spreadsheet.
Page 3 of 7
Revised 3/16/16
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
9.
Does applicant observe a policy and practice of nondiscrimination on the basis of race, color, religion, sex,
disability or national origin, under law, applicable to persons served by the applicant, to applicant staff, and to
membership on the applicant's governing board?
Yes _______ No _______ Please attach a copy of your organization's policy. Please make certain that your
policy addresses clients, staff and board members.
10.
Attach a copy of most recently completed IRS Form 990. This document should not be more than two years old
and should not be the same one submitted last year. Charitable organizations affiliated with national
organizations must submit Form 990 or other financial documentation showing revenues and expenses for
Georgia on an explicitly isolated basis.
11.
Attach a copy of most recently completed annual independent audit (if total revenue exceeds $500,000), or
review (if total revenue is less than $500,000).
12.
Management/general and fund raising costs are _____% of total expenses. If more than 25%, please attach an
explanation. Percentage is computed by adding total management/general and fundraising expenses and
dividing that total by the total expense figure. Please show computation.
13.
Is applicant, and all of its member agencies, a voluntary health, welfare, educational or environmental
restoration/conservation organization that is private, self-governing, non-profit, and authorized or chartered to
operate in Georgia by the Secretary of State's office? Yes
License #________________ No _______
NOTE: License numbers begin with CH followed by 4 numbers, ex. CH 6908. Your organization's registration with
the Secretary of State's Office is required by O.C.G.A. (Official Code of Georgia Annotated) 43-17-5, unless your
organization and/or your member agencies are exempt. (Please see the list of exemptions attached to this
application.) If your organization is required to register, please provide official documentation showing that
your organization (and member agencies for federations) has current fundraising registration with the Office of
the Secretary of State. The license is under Profession-Charities, License Type-Charity. The Secretary of State’s
website is http://verify.sos.ga.gov/websites/verification/Search.aspx?facility=Y
If your registration, or that of your member agencies, has expired and not been renewed, please contact
Secretary of State’s Office at (404) 656-3920 for reinstatement.
Page 4 of 7
Revised 3/16/16
the
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
To the best of my knowledge, the information contained in this application and its attachments is true and correct.
The governing body of the applicant has properly authorized this document. The applicant will comply with the
requirements and mandates of O.C.G.A. 45-20-50 and the State Personnel Board, which governs the State of
Georgia Charitable Contributions Program, the USA PATRIOT Act, and all other applicable state and federal laws.
If applying as a federated charitable organization, applicant organization certifies that its member agencies also
meet all requirements of O.C.G.A. 45-20-50, the State Personnel Board, the USA PATRIOT Act, and all other state
and federal laws. Failure of any organization to meet the requirements stated above will result in the organization
being excluded from the program for one year.
Signed________________________________________________________________________________
(Applicant President - required)
Date ______________________
Signed ______________________________________________________________________________
(Executive Director - required)
Date ______________________
Mail Application to:
SCCP Manager – RE: SCCP Application
HR Administration Division
Department of Administrative Services
200 Piedmont Avenue
Suite 520, West Tower
Atlanta, GA 30334
If you have any questions contact: SCCP Program Manager La Toya Wimbush, by phone 404-651-6084, FAX to (770) 3424245, or by email at sccp@doas.ga.gov.
Page 5 of 7
Revised 3/16/16
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
Charitable Solicitations Act Exemption Information
The Office of the Secretary of State provided the following information, which pertains to the exemption of charitable
organizations from the charitable solicitations registration under O.C.G.A. 43-17-5. (See Item IB on page one of this
application.) This information is provided so that you can determine if your organization is exempt. If you have any
questions regarding this information, please contact the Office of the Secretary of State for clarification.
Below are the registration exemptions under the Charitable Solicitations Act (43-17-9), which is administered by the
Office of the Secretary of State. Current registration, if applicable, is required for participation in the State Charitable
Contributions Program. Federations should submit proof of current registration, if applicable, for each of their
member agencies.
a) The following persons are exempt from the provisions of Code Sections 43-17-5 (the registration section of the
Act)
(1) Educational institutions and those organizations, foundations, associations, corporations, charities, and
agencies operated, supervised, or controlled by or in connection with a nonprofit educational institution,
provided that any such institution or organization is qualified under Section 501(c) of the Internal Revenue
Code of 1986, as amended;
(2) Business, professional, and trade associations and federations which do not solicit members or funds from
the general public;
(3) Fraternal, civic, benevolent, patriotic, and social organizations, when solicitation of contributions is carried
on by persons without any form of compensation and which solicitation is confined to their membership;
(4) Persons requesting any contributions for the relief of any other individual who is specified by name at the
time of the solicitation if all of the contributions collected, without any deductions whatsoever, are turned over
to the named beneficiary; provided, however, that any such person who collects contributions in excess of
$5,000.00 in order to claim benefit of this exemption shall file with the Secretary of State a written accounting
of funds so collected on forms prescribed by the Secretary of State at the end of the first 90 days of solicitation
and, thereafter, at the end of every subsequent 90 day period until said solicitation is concluded;
(5) Any charitable organization whose total gross revenue has been less than $25,000.00 for both the
immediately preceding and current calendar years or which is exempt from filing a federal annual information
return pursuant to Section 6033(a)(2)(A)(i) and (iii) of the Internal Revenue Code and Section 6033(a)(2)(C)(i)
of the Internal Revenue Code;
(6) Any local or state-wide organization of hunters, fishermen, and target shooters which has been recognized
as an organization described in Section 501(c)(3) or Section 501(c)(4) of the Internal Revenue Code, as
amended, or the corresponding provisions of any future federal revenue law;
(7) Religious organizations; or
(8) Political parties, candidates for federal or state office, and political action committees required to file
financial information with federal or state elections commissions.
(b) Local community organizations or local fundraising campaign managers affiliated with or acting for a statewide parent organization by contract or agreement need not register separately with the Secretary of State. The
single registration of the state-wide parent organization shall be considered all inclusive of all of its chapters,
branches, or affiliates and individuals, which will be identified by listing the communities in which they are located
and their directors, as provided in Code Section 43-17-5.
Page 6 of 7
Revised 3/16/16
STATE OF GEORGIA CHARITABLE CONTRIBUTIONS PROGRAM
2016-17 Renewal Application for Inclusion of Charitable Organizations
(c) National charitable organizations having a Georgia affiliate registered under this chapter need not register
separately with the Secretary of State; provided, however, that all records of such national organizations which
relate to charitable solicitations or charitable contributions shall be subject to such reasonable periodic, special, or
other examinations by the Secretary of State, within or outside this state, as the Secretary of State deems necessary
or appropriate for the protection of the public. The Secretary of State shall not disclose this information except to
the extent necessary for investigative or law enforcement purposes.
(d) Charitable organizations which do not solicit or receive contributions from the general public other than
through affiliated organizations registered under this chapter need not register separately with the Secretary of
State; provided, however, that all records of such organizations which relate to charitable solicitations or
charitable contributions shall be subject to such reasonable periodic, special, or other examinations by the
Secretary of State, within or outside this state, as the Secretary of State deems necessary or appropriate for the
protection of the public. The Secretary of State shall not disclose this information except to the extent necessary
for investigative or law enforcement purposes.
You can go to the Secretary of State's web site at: http://www.sos.ga.gov/securities/ for additional information on
exemptions. Once you get to the Charitable rules under Georgia Laws and Rules and Regulations, look at rules 590-96.01, 590-9-6.03 and 590-9-6.04.
If a charitable organization chooses to rely on one or more of the above referenced exemptions, the
responsibility remains with the charity to document and prove such right to claim exemption, if challenged by
the Office of the Secretary of State.
If it comes to the attention of the Secretary of State’s office that the charity is not entitled to the exemption, then the
charity may be subject to enforcement actions for violation of the Georgia Charitable Solicitations Act.
If you believe your organization is not required to file a fundraising registration with the Office of the Secretary of
State based on one or more of the exemptions listed above, you must provide a written statement on your
organization's letterhead stating the exemption that applies to your organization. This statement must be signed and
dated by your Executive Director or President. Federated charitable organizations must provide written statements
in the format given above for any of their member agencies claiming exemption from fundraising registration.
Page 7 of 7
Revised 3/16/16